Aplicações dos biotecidos na cirurgia plástica: Uma revisão sistemática

Resumo

Introdução Biotecidos são combinações organizadas de substâncias sintéticas e/ou biológicas que interagem com sistemas biológicos complexos para tratar, substituir ou remodelar tecidos ou órgãos. A bioengenharia de tecidos emprega diversos métodos, incluindo scaffolds biológicos e sintéticos, com interação com células-tronco e citocinas. Esta revisão examina técnicas e métodos para a síntese de biotecidos, além de sua eficácia em modelos animais e humanos.

Materiais e Métodos Foi realizada uma revisão sistematizada da literatura nas plataformas PubMed, Lilacs, Scielo e Cochrane, utilizando descritores específicos. A análise focou na identificação dos países de origem dos estudos, categorização das técnicas e recursos empregados, visando auxiliar na escolha de estratégias para o uso de biotecidos na cirurgia plástica reconstrutiva.

Resultados Dos 37 artigos selecionados, 15 abordaram experimentação in vitro, 14 in vivo, e 8 utilizaram ambas as abordagens. Os estudos foram classificados em 3 subtemas principais: adipogênese (18 artigos), angiogênese (10 artigos) e condrogênese (nove artigos), todos voltados para reconstruções teciduais.

Conclusão Os avanços no uso de biomateriais na medicina regenerativa são promissores, com experimentos satisfatórios alinhados à cirurgia plástica contemporânea. Embora a aplicação em humanos seja limitada, o potencial das células-tronco e fatores de crescimento sugerem avanços significativos que devem ser melhor desenvolvidos isoladamente em estudos futuros. Esta revisão esclarece as tecnologias e progressos no uso de biomateriais, destacando seu impacto na evolução técnica da cirurgia plástica reconstrutiva.

Palavras-chave

biomateriais - cirurgia reconstrutiva - scaffolds

Contribuições dos Autores

RSA: análise e/ou interpretação de dados, concepção e desenho do estudo, conceituação, curadoria de dados, aprovação final do manuscrito, análise formal, aquisição de financiamento, investigação, metodologia, administração, recursos, supervisão, validação, visualização, preparação do original e revisão e edição da escrita; MGVBM: análise e/ou interpretação de dados, conceituação, curadoria de dados, análise formal, metodologia e preparação do original; NTS: análise e/ou interpretação de dados, concepção e desenho do estudo, conceituação, análise formal, investigação, administração do projeto, recursos, validação e preparação do original; EBG: supervisão, visualização e revisão e edição do texto; LMF: concepção e desenho do estudo, supervisão, validação, visualização, revisão e edição do texto.

Comitê de Ética

CEUA UNIFESP n° 1966101023

Publication History

Received: 09 October 2023

Accepted: 29 September 2024

Article published online:
27 January 2025

• Referências

• 1 Kouniavski E, Egozi D, Wolf Y. Techniques and Innovations in Flap Engineering: A Review. Plast Reconstr Surg Glob Open 2022; 10 (09) e4523
• 2 Parida P, Behera A, Chandra Mishra S. Classification of Biomaterials used in Medicine. Int J Adv Appl Sci. 2012;1(03):
• 3 Gómez S, Vlad MD, López J, Fernández E. Design and properties of 3D scaffolds for bone tissue engineering. Acta Biomater 2016; 42 (June): 341-350 [Internet]
• 4 Sterodimas A, De Faria J, Correa WE, Pitanguy I. Tissue engineering in plastic surgery: an up-to-date review of the current literature. Ann Plast Surg 2009; 62 (01) 97-103
• 5 Flynn LE. The use of decellularized adipose tissue to provide an inductive microenvironment for the adipogenic differentiation of human adipose-derived stem cells. Biomaterials 2010; 31 (17) 4715-4724 [Internet]
• 6 Wang C, Cen L, Yin S. et al. A small diameter elastic blood vessel wall prepared under pulsatile conditions from polyglycolic acid mesh and smooth muscle cells differentiated from adipose-derived stem cells. Biomaterials 2010; 31 (04) 621-630 [Internet]
• 7 Liu X, Sun H, Yan D. et al. In vivo ectopic chondrogenesis of BMSCs directed by mature chondrocytes. Biomaterials 2010; 31 (36) 9406-9414 [Internet]
• 8 Zhang Z, Ito WD, Hopfner U. et al. The role of single cell derived vascular resident endothelial progenitor cells in the enhancement of vascularization in scaffold-based skin regeneration. Biomaterials 2011; 32 (17) 4109-4117 [Internet]
• 9 Wu I, Nahas Z, Kimmerling KA, Rosson GD, Elisseeff JH. An injectable adipose matrix for soft-tissue reconstruction. Plast Reconstr Surg 2012; 129 (06) 1247-1257
• 10 Xue JX, Gong YY, Zhou GD, Liu W, Cao Y, Zhang WJ. Chondrogenic differentiation of bone marrow-derived mesenchymal stem cells induced by acellular cartilage sheets. Biomaterials 2012; 33 (24) 5832-5840 [Internet]
• 11 Alharbi Z, Opländer C, Almakadi S, Fritz A, Vogt M, Pallua N. Conventional vs. micro-fat harvesting: how fat harvesting technique affects tissue-engineering approaches using adipose tissue-derived stem/stromal cells. J Plast Reconstr Aesthet Surg 2013; 66 (09) 1271-1278
• 12 Patel KH, Nayyer L, Seifalian AM. Chondrogenic potential of bone marrow-derived mesenchymal stem cells on a novel, auricular-shaped, nanocomposite scaffold. J Tissue Eng 2013; 4 (01) 20 41731413516782
• 13 Cheung HK, Han TTY, Marecak DM, Watkins JF, Amsden BG, Flynn LE. Composite hydrogel scaffolds incorporating decellularized adipose tissue for soft tissue engineering with adipose-derived stem cells. Biomaterials 2014; 35 (06) 1914-1923 [Internet]
• 14 Mestak O, Matouskova E, Spurkova Z. et al. Mesenchymal stem cells seeded on cross-linked and noncross-linked acellular porcine dermal scaffolds for long-term full-thickness hernia repair in a small animal model. Artif Organs 2014; 38 (07) 572-579
• 15 Han Y, Tao R, Han Y. et al. Microencapsulated VEGF gene-modified umbilical cord mesenchymal stromal cells promote the vascularization of tissue-engineered dermis: an experimental study. Cytotherapy 2014; 16 (02) 160-169 [Internet]
• 16 Mendelson A, Ahn JM, Paluch K, Embree MC, Mao JJ. Engineered nasal cartilage by cell homing: a model for augmentative and reconstructive rhinoplasty. Plast Reconstr Surg 2014; 133 (06) 1344-1353
• 17 Zhang L, He A, Yin Z. et al. Regeneration of human-ear-shaped cartilage by co-culturing human microtia chondrocytes with BMSCs. Biomaterials 2014; 35 (18) 4878-4887 [Internet]
• 18 Garg RK, Rennert RC, Duscher D. et al. Capillary force seeding of hydrogels for adipose-derived stem cell delivery in wounds. Stem Cells Transl Med 2014; 3 (09) 1079-1089
• 19 Gugerell A, Neumann A, Kober J. et al. Adipose-derived stem cells cultivated on electrospun l-lactide/glycolide copolymer fleece and gelatin hydrogels under flow conditions - aiming physiological reality in hypodermis tissue engineering. Burns 2015; 41 (01) 163-171 [Internet]
• 20 Herrero-Mendez A, Palomares T, Castro B. et al. HR007: a family of biomaterials based on glycosaminoglycans for tissue repair. J Tissue Eng Regen Med 2017; 11 (04) 989-1001 [Internet]
• 21 Pati F, Ha DH, Jang J, Han HH, Rhie JW, Cho DW. Biomimetic 3D tissue printing for soft tissue regeneration. Biomaterials 2015; 62: 164-175 [Internet]
• 22 Zeng Y, Zhu L, Han Q. et al. Preformed gelatin microcryogels as injectable cell carriers for enhanced skin wound healing. Acta Biomater 2015; 25: 291-303 [Internet]
• 23 Wahl EA, Fierro FA, Peavy TR. et al. In Vitro Evaluation of Scaffolds for the Delivery of Mesenchymal Stem Cells to Wounds. BioMed Res Int 2015; 2015: 108571
• 24 Lequeux C, Rodriguez J, Boucher F. et al. In vitro and in vivo biocompatibility, bioavailability and tolerance of an injectable vehicle for adipose-derived stem/stromal cells for plastic surgery indications. J Plast Reconstr Aesthet Surg 2015; 68 (11) 1491-1497
• 25 Zhang Q, Hubenak J, Iyyanki T. et al. Engineering vascularized soft tissue flaps in an animal model using human adipose-derived stem cells and VEGF+PLGA/PEG microspheres on a collagen-chitosan scaffold with a flow-through vascular pedicle. Biomaterials 2015; 73: 198-213 [Internet]
• 26 Freiman A, Shandalov Y, Rozenfeld D. et al. Adipose-derived endothelial and mesenchymal stem cells enhance vascular network formation on three-dimensional constructs in vitro. Stem Cell Res Ther 2016; 7 (01) 5 [Internet]
• 27 Ding J, Chen B, Lv T. et al. Bone Marrow Mesenchymal Stem Cell-Based Engineered Cartilage Ameliorates Polyglycolic Acid/Polylactic Acid Scaffold-Induced Inflammation Through M2 Polarization of Macrophages in a Pig Model. Stem Cells Transl Med 2016; 5 (08) 1079-1089
• 28 Hanken H, Göhler F, Smeets R. et al. Attachment, viability and adipodifferentiation of pre-adipose cells on silk scaffolds with and without co-expressed FGF-2 and VEGF. In Vivo (Brooklyn). 2016; 30 (05) 567-72
• 29 Rajabian MH, Ghorabi GH, Geramizadeh B, Sameni S, Ayatollahi M. Evaluation of bone marrow derived mesenchymal stem cells for full-thickness wound healing in comparison to tissue engineered chitosan scaffold in rabbit. Tissue Cell 2017; 49 (01) 112-121 [Internet]
• 30 Du HC, Jiang L, Geng WX. et al. Evaluation of xenogeneic extracellular matrix fabricated from CuCl₂-conditioned mesenchymal stem cell sheets as a bioactive wound dressing material. J Biomater Appl 2017; 32 (04) 472-483
• 31 Steiner D, Lingens L, Fischer L. et al. Encapsulation of Mesenchymal Stem Cells Improves Vascularization of Alginate-Based Scaffolds. Tissue Eng Part A 2018; 24 (17-18): 1320-1331
• 32 Duisit J, Amiel H, Wüthrich T. et al. Perfusion-decellularization of human ear grafts enables ECM-based scaffolds for auricular vascularized composite tissue engineering. Acta Biomater 2018; 73: 339-354 [Internet]
• 33 Griffin MF, Naderi N, Kalaskar DM, Seifalian AM, Butler PE. Argon plasma surface modification promotes the therapeutic angiogenesis and tissue formation of tissue-engineered scaffolds in vivo by adipose-derived stem cells. Stem Cell Res Ther 2019; 10 (01) 110
• 34 Zhu Z, Yuan ZQ, Huang C. et al. Pre-culture of adipose-derived stem cells and heterologous acellular dermal matrix: paracrine functions promote post-implantation neovascularization and attenuate inflammatory response. Biomed Mater 2019; 14 (03) 035002
• 35 Buschmann J, Yamada Y, Schulz-Schönhagen K. et al. Hybrid nanocomposite as a chest wall graft with improved integration by adipose-derived stem cells. Sci Rep 2019; 9 (01) 10910
• 36 Tytgat L, Van Damme L, Van Hoorick J. et al. Additive manufacturing of photo-crosslinked gelatin scaffolds for adipose tissue engineering. Acta Biomater 2019; 94: 340-350 [Internet]
• 37 Tytgat L, Van Damme L, Ortega Arevalo MDP. et al. Extrusion-based 3D printing of photo-crosslinkable gelatin and κ-carrageenan hydrogel blends for adipose tissue regeneration. Int J Biol Macromol 2019; 140: 929-938 [Internet]
• 38 Colle J, Blondeel P, De Bruyne A. et al. Bioprinting predifferentiated adipose-derived mesenchymal stem cell spheroids with methacrylated gelatin ink for adipose tissue engineering. J Mater Sci Mater Med 2020; 31 (04) 36 [Internet]
• 39 Dash BC, Setia O, Gorecka J. et al. A Dense Fibrillar Collagen Scaffold Differentially Modulates Secretory Function of iPSC-Derived Vascular Smooth Muscle Cells to Promote Wound Healing. Cells 2020; 9 (04) 8-10
• 40 Benmeridja L, De Moor L, De Maere E. et al. High-throughput fabrication of vascularized adipose microtissues for 3D bioprinting. J Tissue Eng Regen Med 2020; 14 (06) 840-854
• 41 Pu W, Han Y, Yang M. Human decellularized adipose tissue hydrogels as a culture platform for human adipose-derived stem cell delivery. J Appl Biomater Funct Mater 2021; 19 (33) 22 80800020988141
• 42 Gierek M, Łabuś W, Kitala D. et al. Human Acellular Dermal Matrix in Reconstructive Surgery-A Review. Biomedicines 2022; 10 (11) 2870 https://pubmed.ncbi.nlm.nih.gov/36359387/ [Internet]
• 43 Kerr R, Powis S, Black N. et al. Future of Surgery [Internet]. Royal College of Surgeons of England. 2021. Available from: https://futureofsurgery.rcseng.ac.uk/
• 44 Salehi-Nik N, Amoabediny G, Pouran B. et al. Engineering parameters in bioreactor's design: a critical aspect in tissue engineering. BioMed Res Int 2013; 2013 (03) 762132
• 45 Bourne DA, Thomas RD, Bliley J. et al. Amputation-site soft-tissue restoration using adipose stem cell therapy. Plast Reconstr Surg 2018; 142 (05) 1349-1352
• 46 Yoshimura K, Sato K, Aoi N, Kurita M, Hirohi T, Harii K. Cell-assisted lipotransfer for cosmetic breast augmentation: supportive use of adipose-derived stem/stromal cells. Aesthetic Plast Surg 2008; 32 (01) 48-55 , discussion 56–57
• 47 Zhu M, Zhou Z, Chen Y. et al. Supplementation of fat grafts with adipose-derived regenerative cells improves long-term graft retention. Ann Plast Surg 2010; 64 (02) 222-228
• 48 Scherl A, Coute Y, Déon C. et al. Human Adipose Tissue Is a Source of Multipotent Stem Cells. Mol Biol Cell 2002; 13 (11) 4100-4109
• 49 Solchaga LA, Penick KJ, Welter JF. Chondrogenic Differentiation of Bone Marrow-Derived Mesenchymal Stem Cells: Tips and Tricks. Mesenchymal Stem Cell Assays Appl 2011; 698 (05) 469-470
• 50 De Ugarte DA, Morizono K, Elbarbary A. et al. Comparison of multi-lineage cells from human adipose tissue and bone marrow. Cells Tissues Organs 2003; 174 (03) 101-109
• 51 Nakanishi C, Nagaya N, Ohnishi S. et al. Gene and protein expression analysis of mesenchymal stem cells derived from rat adipose tissue and bone marrow. Circ J 2011; 75 (09) 2260-2268
• 52 Cowan CM, Shi YY, Aalami OO. et al. Adipose-derived adult stromal cells heal critical-size mouse calvarial defects. Nat Biotechnol 2004; 22 (05) 560-567
• 53 Colazo JM, Evans BC, Farinas AF, Al-Kassis S, Duvall CL, Thayer WP. Applied Bioengineering in Tissue Reconstruction, Replacement, and Regeneration. Tissue Eng Part B Rev 2019; 25 (04) 259-290
• 54 Simonacci F, Bertozzi N, Grieco MP, Raposio E. From liposuction to adipose-derived stem cells: indications and technique. Acta Biomed 2019; 90 (02) 197-208
• 55 Mojallal A, Foyatier JL. [Historical review of the use of adipose tissue transfer in plastic and reconstructive surgery]. Ann Chir Plast Esthet 2004; 49 (05) 419-425
• 56 Rupnick MA, Panigrahy D, Zhang CY. et al. Adipose tissue mass can be regulated through the vasculature. Proc Natl Acad Sci U S A 2002; 99 (16) 10730-10735
• 57 Chen L, Xing Q, Zhai Q. et al. Pre-vascularization enhances therapeutic effects of human mesenchymal stem cell sheets in full thickness skin wound repair. Theranostics 2017; 7 (01) 117-131
• 58 Phua QH, Han HA, Soh BS. Translational stem cell therapy: vascularized skin grafts in skin repair and regeneration. J Transl Med 2021; 19 (01) 83
• 59 Hadlock TA, Vacanti JP, Cheney ML. Tissue engineering in facial plastic and reconstructive surgery. Facial Plast Surg 1998; 14 (03) 197-203
• 60 Sylvester KG, Longaker MT. Stem cells: review and update. Arch Surg 2004; 139 (01) 93-99
• 61 Ma HL, Hung SC, Lin SY, Chen YL, Lo WH. Chondrogenesis of human mesenchymal stem cells encapsulated in alginate beads. J Biomed Mater Res A 2003; 64 (02) 273-281
• 62 Li WJ, Tuli R, Okafor C. et al. A three-dimensional nanofibrous scaffold for cartilage tissue engineering using human mesenchymal stem cells. Biomaterials 2005; 26 (06) 599-609
• 63 Ho STB, Cool SM, Hui JH, Hutmacher DW. The influence of fibrin based hydrogels on the chondrogenic differentiation of human bone marrow stromal cells. Biomaterials 2010; 31 (01) 38-47 [Internet]